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Short- and long-term risk stratification in acute coronary syndromes: the added value of quantitative ST-segment depression and multiple biomarkers.
J Am Coll Cardiol. 2006 Sep 05; 48(5):939-47.JACC

Abstract

OBJECTIVES

The purpose of this study was to develop 30-day and 1-year risk stratification models for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients that incorporate quantitative ST-segment depression and novel biomarkers.

BACKGROUND

Several novel biomarkers have changed the risk profile of ACS; thus, the reassessment of traditional indicators such as ST-segment depression in this new context is warranted.

METHODS

Multivariable logistic regression was used to identify significant predictors of 30-day death and death/myocardial infarction (MI) and 1-year mortality in 7,800 NSTE-ACS patients enrolled in the GUSTO-IV (Global Utilization of Strategies to Open Occluded Arteries-IV ACS) trial between 1998 and 2000.

RESULTS

Among all other predictors, the degree of ST-segment depression had the highest prognostic value for 30-day death, 30-day death/MI, and 1-year death. Troponin T (TnT), creatinine clearance, N-terminal pro-brain natriuretic peptide (NT-proBNP), heart rate, and age were also highly influential on adverse outcomes. Unlike TnT and NT-proBNP, C-reactive protein was only predictive of long-term death. In contrast to mortality, the contribution of TnT to predicting 30-day death/MI increased, whereas NT-proBNP's role was attenuated. The discriminatory power was excellent (c-index [adjusted for over-optimism]: 0.82 [30-day death]; 0.72 [30-day death/MI]; 0.81 [1-year]).

CONCLUSIONS

In this large contemporary study of NSTE-ACS patients, novel insights into risk stratification were observed-in particular, the utility of quantitative ST-segment depression and multiple biomarkers. Collection of these indicators in future NSTE-ACS populations is recommended to evaluate generalizability and clinical application of these findings.

Authors+Show Affiliations

University of Alberta, Edmonton, Canada. cindy.westerhout@ualberta.caNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16949483

Citation

Westerhout, Cynthia M., et al. "Short- and Long-term Risk Stratification in Acute Coronary Syndromes: the Added Value of Quantitative ST-segment Depression and Multiple Biomarkers." Journal of the American College of Cardiology, vol. 48, no. 5, 2006, pp. 939-47.
Westerhout CM, Fu Y, Lauer MS, et al. Short- and long-term risk stratification in acute coronary syndromes: the added value of quantitative ST-segment depression and multiple biomarkers. J Am Coll Cardiol. 2006;48(5):939-47.
Westerhout, C. M., Fu, Y., Lauer, M. S., James, S., Armstrong, P. W., Al-Hattab, E., Califf, R. M., Simoons, M. L., Wallentin, L., & Boersma, E. (2006). Short- and long-term risk stratification in acute coronary syndromes: the added value of quantitative ST-segment depression and multiple biomarkers. Journal of the American College of Cardiology, 48(5), 939-47.
Westerhout CM, et al. Short- and Long-term Risk Stratification in Acute Coronary Syndromes: the Added Value of Quantitative ST-segment Depression and Multiple Biomarkers. J Am Coll Cardiol. 2006 Sep 5;48(5):939-47. PubMed PMID: 16949483.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Short- and long-term risk stratification in acute coronary syndromes: the added value of quantitative ST-segment depression and multiple biomarkers. AU - Westerhout,Cynthia M, AU - Fu,Yuling, AU - Lauer,Michael S, AU - James,Stefan, AU - Armstrong,Paul W, AU - Al-Hattab,Eyad, AU - Califf,Robert M, AU - Simoons,Maarten L, AU - Wallentin,Lars, AU - Boersma,Eric, AU - ,, PY - 2006/01/01/received PY - 2006/03/28/revised PY - 2006/04/24/accepted PY - 2006/9/5/pubmed PY - 2006/9/22/medline PY - 2006/9/5/entrez SP - 939 EP - 47 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 48 IS - 5 N2 - OBJECTIVES: The purpose of this study was to develop 30-day and 1-year risk stratification models for non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients that incorporate quantitative ST-segment depression and novel biomarkers. BACKGROUND: Several novel biomarkers have changed the risk profile of ACS; thus, the reassessment of traditional indicators such as ST-segment depression in this new context is warranted. METHODS: Multivariable logistic regression was used to identify significant predictors of 30-day death and death/myocardial infarction (MI) and 1-year mortality in 7,800 NSTE-ACS patients enrolled in the GUSTO-IV (Global Utilization of Strategies to Open Occluded Arteries-IV ACS) trial between 1998 and 2000. RESULTS: Among all other predictors, the degree of ST-segment depression had the highest prognostic value for 30-day death, 30-day death/MI, and 1-year death. Troponin T (TnT), creatinine clearance, N-terminal pro-brain natriuretic peptide (NT-proBNP), heart rate, and age were also highly influential on adverse outcomes. Unlike TnT and NT-proBNP, C-reactive protein was only predictive of long-term death. In contrast to mortality, the contribution of TnT to predicting 30-day death/MI increased, whereas NT-proBNP's role was attenuated. The discriminatory power was excellent (c-index [adjusted for over-optimism]: 0.82 [30-day death]; 0.72 [30-day death/MI]; 0.81 [1-year]). CONCLUSIONS: In this large contemporary study of NSTE-ACS patients, novel insights into risk stratification were observed-in particular, the utility of quantitative ST-segment depression and multiple biomarkers. Collection of these indicators in future NSTE-ACS populations is recommended to evaluate generalizability and clinical application of these findings. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/16949483/Short__and_long_term_risk_stratification_in_acute_coronary_syndromes:_the_added_value_of_quantitative_ST_segment_depression_and_multiple_biomarkers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(06)01460-4 DB - PRIME DP - Unbound Medicine ER -